Time and Material and Labor Hour
Your Company Name
INVOICE
Address 1
Address 2
INVOICE #:_______________
City, ST Zip Code
INVOICE DATE:_______________
Phone:
Fax:
TO:
SHIP TO:
UT-Battelle, LLC
UT-Battelle, LLC for the Department of Energy
Accounts Payable Department
Street Address
PO Box 2308
Oak Ridge, TN 37831-6436
City, ST Zip Code
Email invoice to ornlap@ornl.gov or
Fax to 865-241-1080
Comments or Special Instructions:
UT-Battelle
BILLING PERIOD
Customer
Shipped Via
Subcontract Number
Beginning/End Date
Number
Element Description
Current Amount
Cumulative Amount
LABOR – STANDARD TIME (itemize on attached statements – as shown on
Appendix-A and Appendix-B or other Company Approved Format)
LABOR – OVERTIME* (itemize on attached statements – as shown on Appendix-A
and Appendix-B or other Company Approved Format)
TOTAL LABOR
0.00
0.00
MATERIAL* (itemize on attached statements – as shown on Appendix-C or other
Company Approved Format with receipts)
TRAVEL* (itemize on attached Travel Expense Statement Form(s) or other
Company Approved Format with receipts if required)
Handling Charge* (Material and Travel)
TOTAL MATERIAL AND TRAVEL
0.00
0.00
INVOICE SUBTOTAL
0.00
0.00
RETENTION
TOTAL AMOUNT DUE
0.00
0.00
*
Must be specified in the Agreement
If you have any questions concerning this invoice, contact [Name, phone, e-mail]
CERTIFICATE OF CONFORMANCE
I certify that ______________________(insert Seller's name) has furnished the Direct Labor Hours
(DLH) called for and identified on this invoice in accordance with Agreement No.__________________.
I further certify that the work is of the quality specified and conforms in all respects with the
Agreement requirements, that all amounts invoiced for labor, travel, and other material costs have
been paid, and the amount of this invoice is now due.
Date:
_______________________________.
Signature:
_______________________________.
Title:
_______________________________.
Nov 2014
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BSD-CS-2083